Papers highlighting the difficult issue of ‘off-label prescribing’ are always of interest. ^{Reference Uzoechina, Hilvering, Rogers, O'Brien, Pullela and Yousafzai1} However, in the context of financial restraints and increasing cutbacks, the assertion, taken from the Royal College of Psychiatrists’ guidelines, that such a modus operandi of prescribing requires frequent monitoring may be unhelpful. ^{Reference Holloway2}

Clearly, several combinations of treatments for depression and other conditions might be ‘off-label’, yet they continue to be used regularly. Further, they are documented in widely known prescribing protocols such as the Maudsley guidelines and CANMET-MD, some with an arguably more transparent basis than the National Institute for Health and Clinical Excellence process for formulating guidelines. It might be time for psychiatrists to start using clinically appropriate, positive-risk ‘off-label’ prescribing that, as long as an evidence base has been followed, allows for the time interval between reviews to be increased. We should prescribe what makes a difference for the patient; not what contains the prescriber’s anxiety.